Have you joined our BOTOX CLUB yet?
OUR BOTOX CLUB IS HANDS-DOWN THE BEST WAY TO SAVE HUNDREDS ON BOTOX IF YOU RECEIVE REGULAR SESSIONS.
When you become a member of our exclusive club, you’ll get to enjoy discounts on Botox all year long!
WELCOME TO OUR BOTOX CLUB!
As a member, you receive special pricing for Botox all year! Plus one complimentary facial a year.
The following lists the terms of conditions of our Botox Club. Please read carefully and initial at each line, and feel free to ask any questions.
– I understand that NO REFUNDS or services beyond contract dates are allowed under any circumstance.
– I understand that my membership benefits CANNOT be shared, and do not accrue. Discounts and facial are non-transferrable, and facial does not “roll over” to the following year if unused. I must use the units purchased in a 12 month period.
(Requires a minimum of 40 units per tx.)
By signing below, I indicate understanding of the Botox Club benefits, and the terms and conditions that apply. In addition, I hereby authorize Deborah Longwill DO PA to charge the card listed below for the membership fee.
Botox Consent Form
Please fill out the Botox Membership & Authorization Consent FormHave you joined our BOTOX CLUB yet?
OUR BOTOX CLUB IS HANDS-DOWN THE BEST WAY TO SAVE HUNDREDS ON BOTOX IF YOU RECEIVE REGULAR SESSIONS.
When you become a member of our exclusive club, you’ll get to enjoy discounts on Botox all year long!
WELCOME TO OUR BOTOX CLUB!
As a member, you receive special pricing for Botox all year! Plus one complimentary facial a year.
The following lists the terms of conditions of our Botox Club. Please read carefully and initial at each line, and feel free to ask any questions.
– I understand that NO REFUNDS or services beyond contract dates are allowed under any circumstance.
– I understand that my membership benefits CANNOT be shared, and do not accrue. Discounts and facial are non-transferrable, and facial does not “roll over” to the following year if unused. I must use the units purchased in a 12 month period.
(Requires a minimum of 40 units per tx.)
By signing below, I indicate understanding of the Botox Club benefits, and the terms and conditions that apply. In addition, I hereby authorize Deborah Longwill DO PA to charge the card listed below for the membership fee.
